Insulin secretion measured by stimulated C-peptide in long-established Type 1 diabetes in the Diabetes Control and Complications Trial (DCCT)/ Epidemiology of Diabetes Interventions and Complications (EDIC) cohort: a pilot study.

AIMS: To evaluate whether clinically relevant concentrations of stimulated C-peptide in response to a mixed-meal tolerance test can be detected after almost 30 years of diabetes in people included in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications cohort. METHODS: Mixed-meal tolerance tests were performed in a sample of 58 people. C-peptide levels were measured using a chemiluminescent immunoassay. This sample size assured a high probability of detecting C-peptide response if the true prevalence was at least 5%, a level that would justify the subsequent assessment of C-peptide in the entire cohort. RESULTS: Of the 58 participants, 17% showed a definite response, defined as one or more post-stimulus concentrations of C-peptide > 0.03 nmol/l, and measurable concentrations were found in all participants. CONCLUSIONS: These results show that a stimulated C-peptide response can be measured in some people with long-term Type 1 diabetes. Further investigation of all participants in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications study will help relate long-term residual C-peptide response to glycaemia over time and provide insight into the relevance of this response in terms of insulin dose, severe hypoglycaemia, retinopathy, nephropathy and macrovascular disease. Establishing the clinical relevance of long-term C-peptide responses is important in understanding the impact that therapy to preserve or improve ß-cell function may have in patients with long-term Type 1 diabetes.

Variable virulence among isolates of Ascosphaera apis: testing the parasite-pathogen hypothesis for the evolution of polyandry in social insects.

The queens of many eusocial insect species are polyandrous. The evolution of polyandry from ancestral monoandry is intriguing because polyandry undermines the kin-selected benefits of high intracolonial relatedness that are understood to have been central to the evolution of eusociality. An accumulating body of evidence suggests that polyandry evolved from monoandry in part because genetically diverse colonies better resist infection by pathogens. However, a core assumption of the "parasite-pathogen hypothesis", that there is variation in virulence among strains of pathogens, remains largely untested in vivo. Here, we demonstrate variation in virulence among isolates of Ascosphaera apis, the causative organism of chalkbrood disease in its honey bee (Apis mellifera) host. More importantly, we show a pathogen-host genotypic interaction for resistance and pathogenicity. Our findings therefore support the parasite-parasite hypothesis as a factor in the evolution of polyandry among eusocial insects.

Vitamin D status and recurrent preterm birth: a nested case-control study in high-risk women.

OBJECTIVE: To determine whether vitamin D status is associated with recurrent preterm birth, and any interactions between vitamin D levels and fish consumption. DESIGN: A nested case-control study, using data from a randomised trial of omega-3 fatty acid supplementation to prevent recurrent preterm birth. SETTING: Fourteen academic health centres in the USA. POPULATION: Women with prior spontaneous preterm birth. METHODS: In 131 cases (preterm delivery at <35 weeks of gestation) and 134 term controls, we measured serum 25-hydroxyvitamin D [25(OH)D] concentrations by liquid chromatography-tandem mass spectrometry (LC-MS) from samples collected at baseline (16-22 weeks of gestation). Logistic regression models controlled for study centre, maternal age, race/ethnicity, number of prior preterm deliveries, smoking status, body mass index, and treatment. MAIN OUTCOME MEASURES: Recurrent preterm birth at <37 and <32 weeks of gestation. RESULTS: The median mid-gestation serum 25(OH)D concentration was 67 nmol/l, and 27% had concentrations of <50 nmol/l. Serum 25(OH)D concentration was not significantly associated with preterm birth (OR 1.33; 95% CI 0.48-3.70 for lowest versus highest quartiles). Likewise, comparing women with 25(OH)D concentrations of 50 nmol/l, or higher, with those with <50 nmol/l generated an odds ratio of 0.80 (95% CI 0.38-1.69). Contrary to our expectation, a negative correlation was observed between fish consumption and serum 25(OH)D concentration (-0.18, P < 0.01). CONCLUSIONS: In a cohort of women with a prior preterm birth, vitamin D status at mid-pregnancy was not associated with recurrent preterm birth.

Detection of numerous verotoxigenic E. coli serotypes, with multiple antibiotic resistance from cattle faeces and soil.

Verotoxigenic E. coli (VTEC) belong to a diverse range of serotypes. Serotypes O157 and O26 are predominately identified in VTEC-associated disease in Europe, however due to difficulty in detection little is known about the epidemiology of non-O157 serotypes. This study reports the identification of 7 VTEC serotypes from cattle faeces and soil. Cattle faeces samples (n=128) were taken from animals in 6 different farms, with soil samples (n=20) obtained from 1 farm. After sample incubation in modified tryptone soy broth (mTSB) supplemented with streptomycin sulphate samples were plated onto sorbitol MacConkey (SMAC) also supplemented with streptomycin sulphate. Bacteria detected on the plates were subjected to biochemical testing, antibiotic resistance profiling, and PCR to detect typical virulence genes, beta-lactamase and class 1 integron associated genes. Serotyping was performed on isolates positive for virulence genes. E. coli was identified from 103 samples, with verotoxin genes present in 7 E. coli isolates. Of these 7 isolates, 5 were resistant to 5 or more antibiotics. The isolate resistant to 9 antimicrobials contained a class 1 integron structure. Serotyping identified 7 separate VTEC, O2:H27, O26:H11, O63:H(-), O148:H8, O149:H1, O174:H21 and ONT:H25. Six of these VTEC have been previously associated with human disease, however with the exception of O26:H11, these serotypes have been rarely reported worldwide. Increased surveillance is required to determine the prevalence of these and other non-O157 VTEC. The presence of multi-antibiotic resistance in these isolates is of concern, and the overall implications for public health must be ascertained.

A multicentre longitudinal observational study of changes in self reported health status in people with Parkinson's disease left untreated at diagnosis.

BACKGROUND: The issue of when to start treatment in Parkinson's disease (PD) remains controversial. Some favour treatment at diagnosis while others opt for a "wait and watch" policy. The effect of the latter policy on the self reported health status of people with PD is unknown. AIMS: To record self reported health status through longitudinal use of a validated PD specific questionnaire (PDQ-39) in untreated PD patients in multiple centres in the UK. To compare patients who were left untreated with those who were offered treatment during follow-up. METHODS: A multicentre, prospective, "real life" observational audit based study addressing patient reported outcomes in relation to self reported health status and other sociodemographic details. RESULTS: 198 untreated PD were assessed over a mean period of 18 months. During two follow-up assessments, the self reported health status scores in all eight domains of the PDQ-39 and the overall PDQ-39 summary index worsened significantly (p<0.01) in patients left untreated. In a comparative group in whom treatment was initiated at or soon after diagnosis, there was a trend towards improvement in self reported health status scores after treatment was started. CONCLUSIONS: This study addresses for the first time self reported health status, an indicator of health related quality of life, in untreated PD. The findings may strengthen the call for re-evaluation of the policy to delay treatment in newly diagnosed patients with PD.

The characterisation of E. coli O157:H7 isolates from cattle faeces and feedlot environment using PFGE.

The objectives of this study were to investigate the diversity of Escherichia coli O157:H7 isolates obtained over a 3-month period from a cattle feedlot in order to assess the relationship between environmental and faecal isolates and to determine the pattern of transmission of E. coli O157:H7 between groups of cattle. Faecal samples were obtained from cattle housed in four adjacent feedlot pens at monthly intervals, with environmental pen samples collected simultaneously. All E. coli O157:H7 isolates obtained were examined by pulsed field gel electrophoresis (PFGE), polymerase chain reaction (PCR) to detect eaeA, ehxA, stx1 and stx2 genes and antibiotic sensitivity profiling. Ten isolates were subjected to acid shock to imitate conditions in the acidic cattle abomasum and assess the effect on PFGE profiles. E. coli O157:H7 was isolated from 69 faecal samples and 26 environmental samples. All isolates (n=95) carried the genes for eaeA, ehxA and stx2 and were sensitive to all antibiotics tested. The PFGE profiles of all isolates differed by no more than two bands and clustered within 80% similarity following dendrogram analysis. Acid shock had no effect on the subsequent PFGE patterns. A total of 8.7% (6/69) of cattle were shedding E. coli O157:H7 in the first month with faecal shedding increasing to 52% (36/69) by the third month of the study. A single isolate of E. coli O157:H7 may be passed rapidly through cattle pens, with the environment acting as a significant reservoir for transmission. PFGE is a useful tool for tracking the direct and indirect transmission of E. coli O157:H7 isolates on the farm.

A comparison of the survival in feces and water of Escherichia coli O157:H7 grown under laboratory conditions or obtained from cattle feces.

Escherichia coli O157:H7 is an important foodborne pathogen that can cause hemorrhagic colitis and hemolytic uremic syndrome. Cattle feces and fecally contaminated water are important in the transmission of this organism on the farm. In this study, the survival of E. coli O157:H7 in feces and water was compared following passage through the animal digestive tract or preparation in the laboratory. Feces were collected from steers before and after oral inoculation with a marked strain of E. coli O157:H7. Fecal samples collected before cattle inoculation were subsequently inoculated with the marked strain of E. coli O157:H7 prepared in the laboratory. Subsamples were taken from both animal and laboratory-inoculated feces to inoculate 5-liter volumes of water. E. coli O157:H7 in feces survived up to 97 days, and survival was not affected by the method used to prepare the inoculating strain. E. coli O157:H7 survived up to 109 days in water, and the bacteria collected from inoculated cattle were detected up to 10 weeks longer than the laboratory-prepared culture. This study suggests that pathogen survival in low-nutrient conditions may be enhanced by passage through the gastrointestinal tract.

A survey of assessment and management of velopharyngeal incompetence (VPI) in the UK and Ireland.

A questionnaire designed to survey methods of assessment and management of velopharyngeal incompetence (VPI) was circulated to all surgical members of the Craniofacial Society of Great Britain and Ireland. 45 questionnaires were distributed yielding 30 respondents (66.6% response rate). 27 respondents performed surgery for both cleft and non-cleft forms of VPI. Multi-planar videofluroscopy and nasendoscopy were the most frequently used methods of assessing and diagnosing VPI. The most frequently utilised corrective surgical procedure was palatal re-repair, followed by the Hynes pharyngoplasty and the Furlow double opposing z-plasty technique. Orticochea and Jackson pharyngoplasties were less commonly performed. Splitting the palate during pharyngoplasty procedures was an inconsistent practice. 20 palatal surgeons referred patients to an otolaryngology specialist when tonsillectomy and/or adenoidectomy was indicated prior to their corrective palatal procedure. This was most frequently performed 3 months prior to palatal surgery. This survey identified normal patient speech as the criterion of success after correctional surgery for VPI. Assessment and management of VPI in Great Britain and Ireland is a highly varied practice. When a palatal procedure is indicated, surgical approaches are tailored to address each individual's pattern of velopharyngeal closure deficiency. The surgeons surveyed reported this as being most accurately demonstrated by direct nasendoscopic visualisation and dynamic multi-planar videofluoroscopic studies.

LACK OF SPREAD OF ENDOMYCORRHIZAS OF CENTAURIUM (GENTIANACEAE).

Seedlings of Centaurium died in the absence of inoculum of vesicular-arbuscular (VA) mycorrhizal fungi in a soil low in nutrients. The morphology of endomycorhizas of Centaurium and Eustoma grandiflora (Raf.) Shim, differed from that of commonly studied VA mycorrhizal hosts in that coils, arbuscules and vesicles were formed but rapidly collapsed. Endomycorrhizal infection spread down the roots of Centaurium erythraeq Rafn. when it was grown with a companion plant, Trifolium dubium Sibth. but when grown alone infection was restricted to the vicinity of the inoculum. Several different VA mycorrhizal plants did not become mycorrhizal when inoculated with mycorrhizal roots of Centaurium.

High densities of arbuscular mycorrhizal fungi maintained during long fallows in soils used to grow cotton except when soil is wetted periodically.

Sequential harvests of cotton seedlings grown in soil cores enabled the quantification of the density of arbuscular mycorrhizal fungi to detect the effects of time, cultivation and periodic wetting of the soil. Cotton seedlings grown in soil cores from three locations formed arbuscular mycorrhizas at similar rates when cores were stored dry for up to 18 months. Disturbance of dry cores followed by dry storage for 18 months did not reduce the rate of establishment of mycorrhizas. Periodic wetting and drying of the cores, especially if the cores had first been disturbed, significantly reduced the rate of establishment of mycorrhizas. We suggest that long fallow disorder is possibly caused by falls of rain in clay soils of eastern Australia used to grow cotton. The proportion of the root with mycorrhizas at 3 wk was strongly correlated with the infection at 8 wk. We also suggest that it might be possible to predict maximum levels of infection and early uptake of phosphate of seedlings by determining the proportion of roots that are mycorrhizal 3 wk after emergence of cotton seedlings.

Horizontal transmission of Escherichia coli O157:H7 during cattle housing.

Ruminant livestock, particularly cattle, is considered the primary reservoir of Escherichia coli O157:H7. This study examines the transmission of E. coli O157:H7 within groups of cattle during winter housing. Holstein Friesian steers were grouped in six pens of five animals. An animal inoculated with and proven to be shedding a marked strain of E. coli O157: H7 was introduced into each pen. Fecal (rectal swabs) and hide samples (900 cm2 from the right rump) were taken from the 36 animals throughout the study. Water, feed, and gate or partition samples from each pen were also examined. Within 24 h of introducing the inoculated animals into the pens, samples collected from the drinking water, pen barriers, and animal hides were positive for the pathogen. Within 48 h, the hides of 20 (66%) of 30 cohort animals from the six pens were contaminated with E. coli O157:H7. The first positive fecal samples from the noninoculated cohort animals were detected 3 days after the introduction of the inoculated steers. During the 23 days of the study, 15 of 30 cohort animals shed the marked E. coli O157:H7 strain in their feces on at least one occasion. Animal behavior in the pens was monitored during a 12-h period using closed circuit television cameras. The camera footage showed an average of 13 instances of animal grooming in each pen per hour. The study suggests that transmission of E. coli O157:H7 between animals may occur following ingestion of the pathogen at low levels and that animal hide may be an important source of transmission.

A pilot scheme for the development of evidence-based practice.

This article presents an evaluative account of a pilot scheme that aimed to introduce evidence-based practice in one NHS trust. The scheme was based on collaboration between staff in the quality assurance department and a nurse researcher based in a university. This collaboration enabled three designated staff to develop skills required for evidence-based practice and guide the production of information that could be disseminated to nurses throughout the trust. Evaluation demonstrated that participants had examined eight practice-based topics and devised protocols that could be applied to practice in a range of hospital and community settings throughout the trust. Evaluation also highlighted the importance of ensuring that members of other disciplines are aware of, and feel involved in, new developments even if they are not directly concerned with them.

Development of specialist and advanced practice in North America.

North American literature provides interesting ideas about the nature of specialist and advanced practice which are useful in informing British thinking on these subjects. However, the two roles do not have the same meanings as their British counterparts. Clarification of the terminology used and the roles described are essential if we are to understand the concepts. This article presents an overview of the literature about clinical nurse specialist and advanced practitioner roles within North America and identifies differences and similarities between the two.

Educational issues in transcultural nursing.

Transcultural nursing education is an essential element of the nursing curriculum. There are a number of curriculum designs available but a combination of approaches seems to be the most desirable way forward.

Culturally sensitive and culturally comprehensive care.

Nursing is essentially about caring for others (Leininger, 1988) and it is this emphasis on care that distinguishes nursing from other professions, most notably medicine, which are oriented towards cure. To achieve culturally sensitive care nurses need to develop a knowledge base which incorporates an awareness of their own culture, preferences and prejudices alongside specific information about ethnic groups.

The concept of respect in nursing.

Respect is a central concept in nursing care but is not well defined. Lack of respect for patients dehumanises them and may contribute to abuse and ill treatment. Transcultural care should be based on an understanding of the concept of respect which is shared by all concerned.

Defining nursing practice.

Nursing needs definition. The UKCC has recently proposed three levels of nursing practice: primary, clinical nurse specialist and advanced practitioner. This article examines these roles and illustrates the level of attainment required in relation to wound care.

The research role of the advanced nurse practitioner.

The research role of the advanced nurse practitioner (ANP) is poorly developed in the literature. Clarification of the role is essential if individual nurses are not to be burdened with unrealistic expectations. Organizations need to prepare themselves for research activities and must not expect the ANP to address all the issues involved alone.

Developing a model for theatre nursing.

There has been much debate about the nature of theatre work and whether the activities performed by theatre nurses represent real nursing. This article examines the potential for constructing a nursing model to depict the variety of environments in which theatre nurse's work.

A survey of specialist and advanced nursing practice in the UK.

This article is the result of a 1-year research project which aimed to develop a contemporary account of the expectations of senior personnel in NHS trusts throughout the UK with regard to the roles of specialist nurses (SN) and advanced nurses (AN). A questionnaire was sent to the chief nurses in 490 NHS trusts throughout the UK. Findings highlight the distinctions made by senior personnel regarding the roles of SNs and ANs, employment issues, fields of practice, work activities, advantages and disadvantages of employing SNs and ANs and ways in which all of these factors have changed since the last survey in 1996. Differences were highlighted between the roles of SNs and ANs in terms of fields of practice and the strategies used to evaluate the effectiveness of their posts.